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Original research
Overall survival in older patients with cancer
  1. Beatrice J Edwards1,
  2. Xiaotao Zhang2,
  3. Ming Sun2,
  4. Juhee Song3,
  5. Peter Khalil2,
  6. Meghan Sri Karuturi4,
  7. Linda Pang2,
  8. Yunlong Geng2,
  9. Colin P Dinney5,
  10. Vicente Valero4,
  11. Richard E Champlin6 and
  12. Debasish Tripathy4
  1. 1 Geriatrics and Extended Care, Central Texas Veterans Healthcare System, Temple, Texas, USA
  2. 2 Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3 Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  5. 5 Department of Urologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  6. 6 Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Beatrice J Edwards, Geriatrics and Extended Care, Central Texas Veterans Healthcare System, Mail Code 18, 1901 Veterans Memorial Drive, Temple, TX 76504, USA; bjedwards2400{at}gmail.com

Abstract

Objectives A growing number of patients with cancer are older adults. We sought to identify the predictors for overall survival (OS) in older adults with solid tumour and haematological malignancies between January 2013 and December 2016.

Methods Retrospective cohort study. A comprehensive geriatric assessment was performed, with a median follow-up of 12.8 months. Analysis: univariate and multivariate Cox proportional hazards regression analysis.

Results In this study, among the 455 patients with last follow-up date or date of death, 152 (33.4%) died during the follow-up. The median follow-up is 12.8 months (range 0.2–51.1 months) and the median OS is 20.5 months (range 0.3–44.5 months). Among all older patients with cancer, predictors of OS included male gender, cancer stage, malnutrition, history of smoking, heavy alcohol use, frailty, weight loss, major depression, low body weight and nursing home residence. Traditional performance scores (Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale (KPS)) were predictors of OS. Independent predictors included age >85 years and haematological malignancies. Among solid tumours (n=311) in addition to the above predictors, comorbidity, gait speed and vitamin D deficiency were associated with OS.

Conclusions We identified specific geriatric factors associated with OS in older patients with cancer, and comparable in predictive ability to traditional performance scores such as KPS and ECOG. Prospective studies will be necessary to confirm our findings.

  • survival
  • depression
  • functional impairment
  • social support
  • cognitive impairment
  • older adults with cancer

https://doi.org/10.1136/bmjspcare-2018-001516

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    Footnotes

    • Contributors BJE: conceptualisation, funding acquisition, investigation, methodology, supervision, validation, writing—original draft, and writing—review and editing; developed the study concept, designed the study, monitored the study and revised the manuscript. XZ: investigation, data curation, formal analysis, writing, review and editing; collected the data, cleaned the data, analysed the data, interpreted the data, drafted the manuscript and revised the manuscript. MS: data curation; collected the data and revised the manuscript, project administration. JS: formal analysis; created the statistical analysis plan and analysed the data formal analysis. All other coauthors (MSK, PK, YG, LP, REC, VV, CPD and DT): review and editing; reviewed the manuscript and gave comments and suggestions.

    • Funding The statistical analysis work was supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672), University of Texas MD Anderson Cancer Center.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The University of Texas MD Anderson Cancer Center Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.